Public health services industry

Industry Snapshot

GENERAL INDUSTRY: Health Science

CAREER CLUSTERS: Health Science; Law, Public Safety, and Security

SUBCATEGORY INDUSTRIES: Communicable Disease Programs; Coroners’ Offices; Environmental Health Programs; Food Inspection; Health Inspection; Immunization Programs; Public and Military Hospitals

RELATED INDUSTRIES: Civil Services; Public Safety; Federal Public Administration; Hospital Care and Services; Local Public Administration; Medicine and Health Care Industry

ANNUAL DOMESTIC REVENUES: US$4.5 trillion (government health expenditures; Centers for Medicare and Medicaid Services, 2022)

ANNUAL GLOBAL REVENUES: US$9 trillion (public health spending; World Health Organization, 2022)

NAICS NUMBERS: 622, 923120, 926140

Summary

The public health industry addresses health issues that face both individuals and entire communities. The industry is multifaceted, comprising public safety officials, elected and appointed government leaders, emergency personnel, medical professionals, and scientists and researchers. The mission of this industry is threefold. First, it assesses and monitors the health of populations and groups in order to identify and gauge the extent of health problems. Second, it creates policies by which these issues may be remedied. Third, it studies and promotes the use of health systems.

History of the Industry

Public health concerns and policy have been manifest for millennia. Two thousand years before the first century C.E., ancient civilizations in northern India, and later in Egypt, built cities complete with drainage systems designed to draw away unclean water runoff and sewage from pedestrian walkways and roads. For many of these ancient civilizations, cleanliness was a religious tradition, giving rise to the expression or principle “cleanliness is next to godliness.”

Still, epidemics and transmissions of communicable diseases have been prevalent throughout human history. During the great “liberation of thought” in the fourth and fifth centuries B.C.E. in Greece, considered one of the major milestones in the history of human thought, a serious study of the causes of disease and epidemics was undertaken. Prior to this, disease and epidemics were largely attributed to the meddling of otherworldly beings and gods. The new school of thought in Greece, spearheaded by great philosophers such as Hippocrates (c. 460-370 B.C.E.), sought more earthbound causes. (Hippocrates himself is often referred to as the “father of medicine.”)

The collapse of the Roman Empire around 476 C.E. brought with it a corresponding collapse of public health infrastructures. The Romans, who were famous for their water management and public health systems, suffered defeats by invading forces from European and Arab nations, both in Rome and throughout their realm. Lacking attention, the aqueducts and water systems that characterized the Roman Empire fell into disrepair. The Byzantine Empire, to which much of the former Roman regime migrated after Rome’s fall, assimilated many of the ancient Greek and Roman writings on public health practices. Europe, however, reverted to religious-based thought, and the Dark Ages followed.

During the Dark Ages, sanitation and health issues in Europe increased, exacerbated by the development of large, crowded cities. In fact, Rome’s collapse was immediately followed by a plague. In the centuries that followed the Dark Ages—from which Europe emerged in the eleventh century—European governments began implementing strict cleanliness policies. These policies were designed to keep waste off the streets and to keep markets clean, not only to protect the public health but also to attract traveling consumers.

This renewed focus on public health did not prevent devastating pandemics, particularly as humanity grew closer together through trade and exploration. In the early fourteenth century, the disease known as Black Death arrived in Italy from central Asia. This pandemic originated in China then spread to India, moving along trade routes via fleas that resided on both rats and human travelers. In only a few years, about one-third of the entire population of Europe was dead, having succumbed to the violent illness. The root causes of the illness remain shrouded in mystery. Naturalists at the time speculated that the disease was born in the swamps adjacent to large cities. Later scientists believed it was an outbreak of the bubonic plague, which had appeared on numerous occasions throughout history. Others believed it was a hemorrhagic fever akin to Ebola. The disease itself remains a mystery, as did its cessation: It abruptly disappeared in 1351.

During the era of exploration, European sailors introduced new diseases to the New World. Among these virulent strains was smallpox, a disease prevalent for millennia prior, but not present in either North nor South America. Millions of Native Americans were exposed and died as a result. It was believed that many of the items brought with these Europeans contained the agents of this disease.

In 1918, another public health crisis erupted, this time in an industrialized society. Soldiers returning from World War I had been exposed to countless contaminants and germs while living in the trenches. This exposure was due to the close quarters and unsanitary conditions of the battlefield. Veterans returned home to the United States and elsewhere with coldlike symptoms. Those symptoms erupted into a far more significant and threatening illness—influenza. Influenza would eventually affect one-fifth of the human population. Over a two-year period, 675,000 Americans died of the illness, a number that surpassed the combat deaths in World War I.

The number and severity of the pandemics and outbreaks that have occurred throughout human history have led to an evolution of public health services. Over time, medical experts and political leaders have been joined by policy makers, educators, emergency personnel, and public safety officials seeking to combat threats to public health. Agencies such as the Centers for Disease Control and Prevention (CDC) have been created not only to assess public health risks but also to trace the roots of diseases as they occur. Agencies such as the CDC work alongside the numerous local, state, and national public health departments.

The Industry Today

The public health services industry is a vast network of interconnected agencies, businesses, and institutions. According to the American Public Health Association (APHA), the industry is dedicated to meeting ten goals:

•Monitoring the public’s health status to identify community health problems

•Diagnosing and investigating risks and threats

•Informing, educating, and empowering the public

•Mobilizing community partnerships

•Developing policies and plans that protect and maintain public health

•Enforcing public health laws and regulations

•Providing links and information to people with personal health needs

•Ensuring a competent public health workforce

•Evaluating and reporting on the industry’s effectiveness

•Conducting research to develop new insights into public health threats and innovative solutions to those threats

Because the health of individuals is often connected to the health of others (which is the very principle behind the concept of public health), medical practitioners such as doctors, nurses, and allied personnel are but one part of the broad public health services industry. In fact, the total population of people who work in public health, either directly or indirectly, is innumerable. The APHA, for example, has 25,000 public health workers in its ranks, which does not include its local, state, and federal government partners and associated groups.

Educational opportunities for training in public health are equally innumerable, and there are dozens of major public and private universities that offer advanced degrees in public health. Harvard University, for example, offers one of the country’s leading programs. The program features students from a wide range of backgrounds, including doctors, nurses, researchers, and social scientists. The field of public health entails an equally broad combination of disciplines, including epidemiology (tracing diseases to their sources), sociological analysis, statistics, environmental studies, and even history.

Although the field of public health services is broad and multifaceted, it is not without connectivity. In fact, it is designed to be a network, taking into account elements that previous fields could not because of their historical limitations. Today’s public health services industry is organized in such a way that it can quickly assess public health risks and dangers, trace them back to their foundations, isolate and treat illnesses, implement protective government policies, communicate with the public on the issues at hand, and even introduce programs designed to prevent further spread of the negative agent or illness.

Medical Practitioners

Doctors and other health providers are often the first to encounter emergent public health threats. In the course of treating patients, they note patterns of illness and unusual symptoms, and they are responsible for notifying public health agencies of any worrisome anomalies. In addition, in the twenty-first century, it is possible for groups of medical practitioners to identify patterns accidentally: Reports of symptoms observed at clinics, hospitals, and other sites are aggregated and analyzed by agencies such as the CDC, so no individual front-line doctor needs to recognize an anomaly in order to sound the alarm. Conscientious reporting of seemingly innocuous data may be enough.

Potential Annual Earnings Scale. According to the US Bureau of Labor Statistics (BLS), the median salary of a physician or surgeon in 2022 was at least $227,180, depending on specialty. Registered nurses earned a median pay of $81,220 per year. Additionally, health technologists and clinical laboratory personnel earned about $48,560 per year in median pay, while orderlies and nursing assistants earned a median wage of $35,760.

Clientele Interaction. The relationship between medical professionals and their patients is held in the highest regard. Patients under the care of a medical professional must feel that the individuals who are caring for them are focused fully on their needs. Put simply, the medical professional’s interaction with the patient is the most important part of the job.

Amenities, Atmosphere, and Physical Grounds. The environment in which a medical practitioner works is highly professional. Medical facilities, by the nature of the work performed in them, are normally impeccably clean and bound by professional protocols and rules. These rules are imposed either by the institutions themselves or by the local, state, or federal government. The environment is typically very high paced, with a great many bureaucratic systems in place to ensure that each patient is properly attended, in spite of the high volume of patients who may be on site.

Typical Number of Employees. The number of employees working in a health care institution varies. Some hospitals employ hundreds of doctors and nurses, while some smaller medical groups may employ only a dozen or fewer. These employees include doctors and nurses and may also include on-site medical technicians, such as laboratory assistants and phlebotomists (blood work specialists), as well as physician assistants.

Traditional Geographic Locations. Facilities that house medical practitioners are found in or near most cities and towns and in central locations in rural areas. They are typically situated near the highest concentrations of current and potential patients.

Pros of Working for a Medical Facility. A medical facility such as a hospital, medical practice, or physician group offers employees a fast-paced workplace with numerous challenges. There is no typical work schedule, as medical workers encounter an unpredictable environment in which the treatment required for each patient is different. Medical facilities also make available to employees a wide range of resources, such as medical labs, libraries, and medical technologies. Such facilities also present medical professionals with candidates for case studies and, as a result, opportunities to write and publish scholarly articles.

Cons of Working for a Medical Facility. Medical facilities are bound by budgetary constraints that are dictated by the revenues generated by patients and their insurance carriers. In medical facilities that administer to poor patients, reimbursement by the government is considerably less than reimbursement from insured patients. Budgets are therefore often very tight in such instances, limiting medical professionals’ ability to earn higher salaries, as well as the resources available to address public health needs. Additionally, nurses are often part of a union, which means that salaries and benefits must be negotiated at the end of every contract. Medical professionals also work long hours, as patients may require around-the-clock care.

Costs

Payroll and Benefits: Doctors are generally paid either on a salary or on a fee-for-service basis. The latter requires them—or their home institutions—to navigate both private and public bureaucracies in order to receive payment, arguing with insurance claims departments and Medicare administrators, for example, over whether a given service was covered. Other medical staff may be paid annual or hourly wages, depending on the position. In many cases, they are represented by collective bargaining units.

Supplies: Medical facilities and practices require a number of supply types. For the purposes of patient recording and management, they require a number of office supplies, such as computers, paper products, and other administrative goods and hardware. They also need a great deal of medical products and hardware, ranging from stethoscopes, intravenous (IV) bags, and surgical tools to heavy machinery such as computed tomography (CT) scanners and electrocardiographs (ECGs). They must also have basic supplies for patients, such as gowns, bedding, and other materials. Finally, they must have on site a sizable volume of medications, surgical supplies (such as gloves, scrubs, and masks), and other important items.

External Services: Medical facilities may outsource security, cafeteria positions and catering, audiovisual support, and maintenance and custodial services.

Utilities: Depending on the size of the medical institution, a sizable portion of its budget may be dedicated to electricity, water, and sewage. Telephones, cable television, and Internet access are also common expenses.

Taxes: Medical professionals are subject to income taxes and sales taxes. In the United States, federal and state exemptions from commercial real estate, sales, lodging, and other taxes vary based on state law. For example, hospitals are generally exempt from local commercial real estate taxes, but private practices may not be granted similar exemptions.

Government Agencies

Federal and local governments monitor public health and formulate and implement plans to safeguard and improve health, both over the long term as a matter of policy and in response to short-term crises and disasters.

Potential Annual Earnings Scale. The pay scale for public health personnel employed by local, county, regional, state, or federal government agencies and departments varies based on the position held and the level of government, as well as the geographic location of the position. The median annual salary for a medical and health services manager at a public health agency in 2022 was $104,830, according to the BLS.

Clientele Interaction. Client interaction is extremely important to public health officials’ endeavors. Departments of public health must frequently create and maintain outreach programs that provide the public with the most up-to-date information about public health risks and threats. Such programs involve frequent meetings with private citizens, in either group or individual settings, to ensure the delivery of the information. Public health departments must also enforce relevant laws and, because of this mandate, must consistently be in direct contact with individuals, businesses, and others within their jurisdictions.

Amenities, Atmosphere, and Physical Grounds. The atmosphere of a national, state, county, regional, or local department of public health is a professional one. Most are located in government buildings, either occupying space in larger office buildings or as sole tenants. Much of their work entails managing a great deal of paperwork, including research reports, program summaries, and inspection reports. Depending on the size of the organization and the project or issue with which the department is faced, the work environment may be slow- or fast-paced. Nonetheless, the environment demands a high level of clerical organization and administrative order.

Typical Number of Employees. Government agencies and departments dedicated to public health services vary in size based on the level of government, as well as the jurisdiction involved. Some local public health departments are composed of only a few employees (such as an office administrator and local inspectors), while larger departments, particularly those on the state and national levels, employ hundreds if not thousands of people to oversee their coverage areas.

Traditional Geographic Locations. Departments of public health and other government agencies dedicated to addressing public health concerns are located throughout a given political system. Federal agencies in the United States are based in Washington, DC, but they have offices in each of the states in order to coordinate with Washington. County and regional governments usually have public health departments located in the largest city or town in the area, usually a county seat. The CDC is headquartered in Atlanta, Georgia.

Pros of Working for a Government Agency. Government agencies and public health departments have access to a wide range of resources that may be of great use to them in their pursuits. This range extends to Washington, DC, in the case of the United States, where many of the nation’s public health policies and regulations are created. This point is important, as it means that even local government employees have the same information available to them. Benefits may also be above competitive levels, since governments negotiate reasonable rates for employee insurance, investment strategies, and other benefits.

Cons of Working for a Government Agency. Because national, state, and local laws and regulations pertaining to public health are either uniform or expected to be compatible with one another, it may be a challenge to implement a new regulation in an area that may not fit the profile of the regulation. Regulations that are broadly imposed may not be easily enforced by a given local agency as a result of geography, sociological differences, or other factors. As a result, public health agents may become frustrated in their attempts to implement strategies that are not specific to their regions’ demographics. Additionally, funding for programs is not always consistent or equitably distributed among agencies. Some cities receive more money from a state or national government than do others for a number of reasons, and this imbalance of distribution may affect an agency’s ability to meet its goals and requirements.

Costs

Payroll and Benefits: Most public employees are paid salaries that are regulated by set pay scales and rules created and modified by legislative bodies. Public employees also tend to receive generous benefits. In some cases, much of public health policy implementation falls not to a paid staff but to a volunteer board of health (some members of which may earn small stipends for their work).

Supplies: Departments of public health and other government agencies must have the necessary supplies to operate a strong administrative system, such as office supplies, computers, copiers, and similar equipment. They may also require field supplies, including hazmat (or hazardous materials) suits, vehicles, and contaminant-detection hardware.

External Services: Public health agencies and departments may outsource a number of duties, including building security, transportation, printing, public relations, and custodial and maintenance services. Government agencies, particularly national agencies, may also engage private laboratories to analyze contaminants and other substances to determine their public health implications.

Utilities: Like most office environments, public health agencies pay for utilities such as telecommunications services, electricity, water, sewage, and similar services. Their rates may be less than those paid by private companies, as government agencies often negotiate lower rates directly with utility companies.

Taxes: Government agencies require their employees to pay income taxes. In many cases, however, employees on official government business are exempt from state and local sales taxes, excise taxes, and other assessments; such exemptions tend to occur on a state-by-state basis.

Nonprofit Organizations

Nonprofit organizations relating to public health range from professional advisory organizations, such as the American Heart Association, to political advocacy groups, such as ACT UP, to nongovernmental organizations, such as the Red Cross. All attempt to improve public health, whether by demanding that more public resources be spent on a particular health problem or constituency, by disseminating useful information to the public, or by administering directly to those in need.

Potential Annual Earnings Scale. Nonprofit organization salaries tend to be lower than the salaries of equivalent functions in the private and public sectors. Executive directors and association leaders tend to earn the highest salaries in such organizations, while administrative assistants and similar personnel are paid at the lower end of the organization’s salary schedule. According to the BLS, the median annual salary for social and community service managers in 2022 was $74,240.

Clientele Interaction. Nonprofit public health organizations usually spend the bulk of their time working with clients, communicating with them directly via local or regional meetings. Such an approach gives an organization opportunities to have a more intimate relationship with the people it serves and therefore helps it increase its impact on those people. Client interaction is therefore essential for nonprofit organizations.

Amenities, Atmosphere, and Physical Grounds. Nonprofit organizations operate in professional office environments, but because of their client- and public-service-oriented missions, they may occupy smaller offices, preferring their employees to work with clients in the field. They are often less formal in terms of dress code but nonetheless remain dedicated to meeting their stated goals and benchmarks.

Typical Number of Employees. Nonprofit organizations vary in size, depending on the scope of services they provide and the number of clients served. Some are very small, employing only a handful of full-time personnel. Others, however, may be considerably larger, with subsidiary organizations serving as part of a national or international network. These organizations may employ hundreds and even thousands of people on a full-time or consultative basis, as well as engaging a large number of volunteers.

Traditional Geographic Locations. Nonprofit organizations are often located in major urban centers and capital cities, as many of them have vested interests in social and budget policy decisions at the government level. Additionally, many are found in areas heavily populated by those with whom they work, such as American Indian reservations and other impoverished regions where public health issues may become manifest.

Pros of Working for a Nonprofit Organization. Individuals who work at nonprofit public health organizations enjoy an ability to interact more directly and consistently with affected clients than do the employees of hospitals and government agencies. Those with a passion for addressing a specific public health issue—such as acquired immunodeficiency syndrome (AIDS), cancer, or childhood obesity—may enjoy the one-on-one interaction with clients that nonprofits create. Additionally, the relative informality of many nonprofit organizations may appeal to those who do not wish to wear professional clothes to work or be bound by strict professional codes of conduct.

Cons of Working for a Nonprofit Organization. Nonprofit public health organizations are often hampered by a lack of donations or government grant monies, particularly during economic downturns. In the light of this fact, many of their programs may be cut short by budgetary constraints. Similarly, employees tend to have lower salaries and more limited benefits than do workers in other sectors of the industry. The relatively small size of many nonprofits limits opportunities for upward career mobility.

Costs

Payroll and Benefits: Nonprofits’ employees are usually paid on a salary or contractual basis. Organizations funded primarily by grants often tie salaries to grants. That is, a grant will fund a particular position or positions for the duration of a particular project. For the position to continue beyond the term of the project, further grants must be found.

Supplies: Nonprofit public health organizations predominantly require stationery, filing materials, and related office supplies. They also need computers, telecommunications hardware, and other administrative supplies and equipment. Organizations whose personnel work in the field may also require cellular telephones, smart phones, laptop computers, and radios.

External Services: Smaller nonprofits in particular often outsource computer and networking support, publishing and copying services, and accounting and tax services. Organizations that hold large events and charitable receptions usually contract event planners, caterers, and related services.

Utilities: Nonprofit organizations are expected to pay basic utilities, such as electricity, telephones, and heat. In many cases, however, their rates are considerably lower than normal, negotiated with providers on the basis of the organization’s limited budget and altruistic nature. In other situations, many of the utilities will be included in the organization’s lease, creating a one-payment system.

Taxes: Nonprofit public health organizations are typically exempt from a wide range of taxes, including federal income taxes, provided they meet certain government-imposed criteria. For example, in the United States, charitable organizations that spend no more than 10 percent of their time on lobbying and that do not share profits among shareholders may qualify as 501(c)(3) groups. This status exempts them from most federal taxes and many state and local taxes, although personnel must still file personal income tax returns, and the organizations are still responsible for payroll taxes on employee salaries.

Academic Institutions

Academic institutions conduct research critical to understanding the nature of illnesses and other public health and safety threats. Like nonprofit organizations, academic institutions’ activities are often funded on a project-by-project basis by specific government or private grants. Indeed, academic scholars in the sciences are expected to conduct research precisely because it brings funding into their home institutions.

Potential Annual Earnings Scale. Salaries and earnings among academic institutions dedicated to public health research vary based on the size of the university’s endowments and any grants that are provided either by the university or by external sources (such as corporate groups or the government).

Clientele Interaction. Client interaction among university-based public health researchers varies based on the requirements of the grant or program being conducted. The client of an academic researcher is usually the researcher’s host university or the company or government entity providing the grant. Researchers may be required to report their findings to their clients on a quarterly or annual basis, if not upon completion of the project.

Amenities, Atmosphere, and Physical Grounds. Academic public health faculty and researchers tend to be based at larger universities, which provide them with access to a greater amount of resources. The environment of research institutions is typically professional and may or may not require business attire, depending on the nature of the work performed. Academic institutions are dynamic, and public health research departments may abut other departments that provide undergraduate and graduate education as well as research.

Typical Number of Employees. Academic institutions’ public health research offices vary in size based on the scope of the work performed. Some groups are very small, composed of a single researcher and an administrative assistant, while others are much larger, as they require the analysis of a great deal of data. The amount of available grant money and other funding also contributes to an institution’s ability to expand its staff to conduct larger analytical activities.

Traditional Geographic Locations. Public health departments are usually located near or within university campuses. Their geographic locations often determine the resources that are available to them, including recruiting pools and technological systems that will aid them in conducting their research. In other cases, they have smaller operations located closer to their areas of study, such as impoverished rural areas or regions affected by environmental hazards.

Pros of Working for an Academic Institution. Academic institutions offer a wide range of resources, often across the spectrum of public health (including economics, sociology, environmental engineering, and public policy, as well as medicine). Public health researchers may therefore enjoy an ability to conduct research that encompasses a broader perspective than they might find in a hospital or as part of a government agency. Many of these work environments are not as formal in terms of professional decorum, which may appeal to those who prefer to work in a less structured environment.

Cons of Working for an Academic Institution. One of the most difficult challenges of working on a public health-related project within an academic institution is the fact that such projects rely on grants, endowments, and government-imposed budget earmarks that may not be renewed from one year to the next. A team may thus go from operating with a sizable budget to working under extremely strict conditions (if its project does not lose funding altogether). Additionally, those personnel who prefer a degree of client interaction may not find a solely academic setting conducive to such interaction. Finally, those who are used to working in a corporate or government setting that establishes strict benchmarks and goals may find the flexibility and informality of academic work frustrating.

Costs

Payroll and Benefits: Academic workers are often paid salaries or contractually through project-based grants. Full-time academics earn salaries but may supplement those salaries with grants, while they are often expected to secure sufficient grant money to pay the wages of their research assistants.

Supplies: Academic institutions performing public health studies require basic office supplies, such as telecommunications equipment, computers, and basic desktop materials. In addition, they must be equipped with laboratory materials and supplies, waste-management facilities (if medical waste is produced), and the necessary computer modeling and statistical software.

External Services: Although many major universities and academic institutions are self-sufficient, a number of important external vendors may be called upon. For example, a public health department that utilizes medical samples may need a vendor that is equipped to dispose of such waste. Universities also often contract telecommunications providers.

Utilities: Universities must pay for telephone, electricity, and energy usage, as well as water and sewage. Large institutions often negotiate lower than average rates for such utilities.

Taxes: In general, institutions of higher learning are exempt from real estate taxes and federal taxes. In the United States, those exemptions require that any revenues generated from grants, philanthropic donations, and endowments be used to fund research and education and not to generate profits.

Public Safety

Public safety personnel are the first responders to any public health crisis. They rescue those in danger, treat people suffering from illness and other health defects, and protect and separate the general public from sources of danger.

Potential Annual Earnings Scale. Salaries for public safety personnel vary based on experience, geographic location of the position, seniority, and the frameworks established by collective bargaining. According to the BLS, the national median salary for police and sheriff's patrol officers in 2022 was $65,790 per year. The median for firefighters and fire prevention workers was about $51,680 per year, and the median for emergency medical technicians (EMTs) and paramedics was $36,680 a year.

Clientele Interaction. Police, firefighters, paramedics, and other first responders encounter and aid people in crisis. In the event of a dangerous public health event, they are typically the first units to arrive on the scene. Client interaction is therefore a constant component of the job. Because such personnel are called upon to intervene in emergency situations, the interaction between them and private citizens can be of a confrontational nature.

Amenities, Atmosphere, and Physical Grounds. Public safety officers are usually expected to be mobile. Some work in patrols, while others stay in their headquarters until called by emergency dispatchers. All are subject to such emergency dispatch calls. When they are at headquarters, they fill out reports, conduct inventory, and perform maintenance on vehicles and equipment. Public safety is a high-stress environment, largely because it generates often confrontational relationships between officers and the many private citizens with whom they must interact.

Typical Number of Employees. Public safety departments vary in size based on the size of the jurisdiction covered. For example, major cities such as New York and Chicago each employ thousands of police officers, while many smaller communities employ only a few dozen. The number of paramedics in a particular location also depends on the size of the community, as well as the nature of the department (some are privately owned and operated, while others are publicly operated through fire departments).

Traditional Geographic Locations. Police, fire, and paramedic personnel are located in or near every municipality and county in the country. In most urban and suburban locations, there are a number of fire stations. In many cities, there are multiple police district offices in addition to the main police headquarters. In rural environments, public safety departments are usually based in county seats or larger municipalities, and personnel patrol outlying areas.

Pros of Working for a Public Safety Department. Working as a police officer, firefighter, or paramedic can involve a great deal of excitement. Such employees often place themselves at great risk to protect the lives of others. When they retire, they and their families generally receive strong retirement benefits, including insurance.

Cons of Working for a Public Safety Department. Public safety work is dangerous. In public health situations, officers may be exposed to dangerous chemicals or fumes, virulent diseases and blood, and violent patients and situations. Additionally, police and firefighters are paid by way of contracts negotiated with the cities or counties in which they operate; when budget dollars are short, they may lose pay or even their jobs as a result of budget austerity. Many officers, paramedics, EMTs, and firefighters experience trauma in their daily work that can have serious psychological repercussions over time.

Costs

Payroll and Benefits: Pay and benefits for public safety officers are dependent on the geographic location of the posting and the negotiated salary structure (unless, like many ambulance companies, the organization is private).

Supplies: Public safety officials require office supplies, uniforms and protective clothing, and hardware and vehicles, including weapons, firefighting equipment, trucks, radios, and logistical systems.

External Services: Most public safety departments are self-sufficient or maintained by other government entities. However, in many cases, police, fire, and paramedic vehicles must be maintained and repaired by external mechanics. Additionally, most equipment, such as weapons, bullet-proof vests, flame-retardant suits, and medical supplies may be maintained by the private vendors from whom it is purchased.

Utilities: Public safety departments use a great deal of electricity, water, and telephone services, which come out of department or city budgets. Additionally, they use a large amount of fuel, particularly for trucks and patrol vehicles.

Taxes: Public safety departments are public, government entities and, as such, are exempt from most state and federal taxes. Personnel must, however, pay personal income taxes and other assessments. Many paramedic and ambulance organizations are privately owned and operated, and their tax-exempt status is determined on a state-by-state basis.

Industry Outlook

Overview

The public health services industry is a diverse and complex network, composed of a number of large individual industries. Its composition is reflective of the complexity of public health itself. Public health services do not focus entirely on treating epidemics of disease or other emergencies; they also take into account lifestyle issues, such as obesity, diet, tobacco use, sexual activity, and alcohol abuse, because such issues can create social groups whose conditions affect others in the community.

Additionally, public health has a political significance. Many government social services are geared toward those with health conditions who cannot afford treatment. Increased volumes of people with tobacco-related illnesses (such as lung cancer and emphysema) who receive health care through Medicaid and other government care programs increase the financial strains on such programs. Furthermore, because public health emergencies warrant emergency money and services, political leaders have a vested interest in implementing preventative public health policies and regulatory measures.

The public health industry continues to grow. Several of its components form some of the largest industries in the world. In 2022, for example, the US health care industry provided more than 14.7 million jobs. Health care spending in the United States is also among the highest in the world, with an average of $13,493 per person spent in 2022.

In the United States, public health is expected to hold the spotlight both as a political issue and as a critical public service. In the early 1990s, the Bill Clinton administration attempted to pass comprehensive reform of the health care system, citing the need to provide affordable health care to all American citizens. The Barack Obama administration renewed this effort, passing through Congress the Patient Protection and Affordable Care Act of 2010. It was repeatedly pointed out throughout the yearlong debate over this measure that total health care expenditures in the United States account for approximately one-sixth of the entire US economy. Enrollment for insurance through the Affordable Care Act, or ObamaCare, started in the fall of 2013 and went into effect as of January 1, 2014. In 2020, the national health care expenditure was 19.7 percent of the United States gross domestic product (GDP), according to the Centers for Medicare and Medicaid Services.

The continuing emergence of viruses and infectious diseases in the integrated global community gives rise to a continued need for public health outreach. This was especially evident in 2020 when a highly contagious virus sparked the global COVID-19 pandemic that left more than 6.5 million people dead by late 2022. Threats from the so-called swine flu (also known as H1N1), eastern equine encephalitis (EEE), Creutzfeldt-Jakob disease (the human form of “mad cow disease”), Ebola, Zika, and Lyme disease provide evidence of the ongoing need for active public health services in the twenty-first century. Similarly, the fact that so many developing nations are still experiencing communicable diseases in nearly epidemic proportions represents an imperative for public health services to continue to work with poor countries to combat the spread of HIV/AIDS, tuberculosis, hemorrhagic fever, and other epidemics. These diseases, which may be treatable and curable, if left unchecked can afflict large populations and ultimately spread to the rest of the world, as residents of affected regions travel to other countries.

The public health services industry will most likely continue to remain one of the most vibrant industries, not just in the United States but also across the globe. The continuing need to protect against epidemics and outbreaks, coupled with the recognition that dangerous lifestyles have an impact on entire communities, leads to the conclusion that public health services remain an important part of the twenty-first century global community.

Employment Advantages

The diversity of the public health services industry offers potential employees an extremely broad range of subfields in which to operate. Employees in this industry may have backgrounds in politics, medicine, sociology, environmental studies, education, public relations, or law enforcement. While this diversity allows for a great deal of individual career growth, people who work within the industry are part of a network, working as an interconnected team either in the event of a public health emergency or when addressing ongoing public health issues. This network is integral to ensuring that public systems and infrastructures do not create public health dangers.

While public health work requires a focus on the individual tasks of each component of the industry, public health services personnel also have the benefit of taking a broader view of the effects of certain conditions and behaviors on communities at large. Individual patients are important, but the systematic effects of their conditions on finances, emergency capabilities, and response times are equally critical in the eyes of public health professionals. This distinction is notable because such a broad focus can help prevent major public health crises from beginning or spreading.

Annual Earnings

The public health services industry is difficult to quantify in terms of earnings, particularly because a large percentage of it is nonprofit. Many activist organizations, community health centers, universities, and political institutions do not generate revenues or have government-initiated appropriations that mandate both public health services and extraneous activities in the same appropriation. According to a 2015 study by the US Internal Revenue Service, however, nonprofit hospitals in the United States took in about 5 percent of overall revenue as excess profits after expenses. According to the Centers for Medicare and Medicaid Services (CMS), the national health care expenditure in the United States was $4.5 trillion in 2022, a 4.1 percent increase over the previous year. Of that total, $944.3 billion was spent on Medicare and $805.7 billion on Medicaid. The CMS also reported that hospital spending was $1,355 billion in 2022. According to the World Health Organization, global health care expenditures was US$9 trillion in 2022.

Industry earnings for nonsupervisory personnel working in the public health sector are generally higher than those working in other industries. It is believed that, in times of both economic boom and stagnation, this industry will continue to expand and hire individuals at pay scales above the national average in the United States and abroad.

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